MentorVIEW With Darlene Mednick
Vice President of Pharmacy Relations for Merck-Medco Managed Care

Darlene Mednick is vice president of pharmacy relations for Merck-Medco Managed Care in Franklin Lakes, N.J. She is a charter member of the Academy Managed Care Pharmacy and has served as chairperson and vice chair of the AMCP's Membership and Professional Practice Committees. Currently she serves on the AMCP editorial advisory board for the Journal of Managed Care Pharmacy [JMCP].

We need to let pharmacists know that there are a lot of options that maybe they don't know about.
_{Darlene Mednick}

PNOW: In a tight labor market, Merck-Medco has been able to hire more than 1,060 pharmacists since February 2000. Why have you been so successful at recruiting?

DM: We have a managed care pharmacy practice setting that is very different from the retail community practice setting or hospital. It offers pharmacists very diverse career opportunities. There are probably 30 different departments across Merck-Medco where there are pharmacists in specific roles and, even within those departments, pharmacists at different levels.

PNOW: Can you give us an example?

DM: We have pharmacists who are staff pharmacists, clinical specialists in specific areas, supervisors, managers and directors of pharmacy practice. We also have pharmacists as clinical account executives which means they are part of an account management team serving a large client like GE or Motorola or the Federal Employees Program. We have pharmacists who are clinical educators. We have pharmacists who are in drug information, clinical policy and formulary management. We have pharmacists in e-commerce and our marketing department who are working on formulary and targeted DUR programs. We also have pharmacists in our outcomes research, medical policy and programs departments.

PNOW: Merck-Medco lets prospective applicants know there are lots of opportunities for variety and career growth. How important is that for pharmacists who are right out of college?

DM: This is an increasingly important decision point for pharmacists. It is equally important for new practitioners who are thinking about their long-term career growth, and for more experienced practitioners who are looking to make a change either because of the newer roles for pharmacists or the increasing importance of understanding managed care principles and practices.

PNOW: You employ a large number of pharmacists. What kind of turnover are you experiencing with the pharmacy positions?

DM: I have tracked that over the last year and a half and also looked back as well as I could at the data. We have about a 95 percent retention rate which is incredibly high especially given the market place and the fact that a lot of our competitors are raising their salary or offering other things - whether it's sign-on bonuses that are huge for a two- or three-year work commitment or cars or things like that. We are competing with other things that I think are ultimately more important like the career opportunities, tuition reimbursement, training and development, and long-term benefits.

PNOW: What aspects of Merck-Medco make it particularly appealing to pharmacists?

DM: We have four different types of pharmacies. There are close to 200 pharmacists at many who do no product dispensing. The pharmacists are involved in pure clinical, cognitive types of activities that they've been trained, educated and aspire to do. For example, we have call center pharmacies where pharmacists are solely involved with drug information, patient counseling and prescriber information. They don't do any product dispensing. Then we have clinical/cognitive pharmacies in Spokane, Wash., Cincinnati and Dallas that again involve no product dispensing. The pharmacists are involved in clinical/cognitive aspects of the drug therapy management. The dispensing for most pharmacies is done by a state-of-the-art, totally robotic central fulfillment pharmacy; there is one in Las Vegas and one that's opening in October in Willingboro, N.J. If you think about why a lot of people either say they are under a tremendous amount of stress or they spend the bulk of their time doing part of a job that they typically do not like -- distribution, dispensing, delivery -- we have removed that and replaced it with technology or technicians which frees up the pharmacists to focus on what they want to do.

PNOW: Do you think a hospital, retail chain or retail pharmacy can create an environment similar to what you've done at Merck-Medco?

DM: This is truly the model for the "Pharmacy for the Future". It's taking a tremendous amount of investment resources in technology and in training pharmacists. Many of the pharmacists who were trained years ago maybe gravitate toward that dispensing, distribution function and they are very comfortable there. To pull them to the front end of the process and have them involved in the clinical and cognitive aspects sometimes requires some additional training. Some are comfortable with it, some are not. So we have created an environment that's almost like virtual pharmacy. You can have a pharmacist at the front end doing the assessment, the validation, all of the clinical intervention, and you can have a pharmacist in central fulfillment working on quality assurance, compounding and dispensing of unit dose products. The patient then receives the prescription at their home and can easily pick up the phone or increasingly use the Internet to ask a question of one of our pharmacists at our call centers. This is increasingly attractive to patients because of the privacy and convenience of contacting a pharmacist from their home. It also provides a higher level of quality care because then the pharmacist is totally focused on that patient for whatever amount of time they need. So you have a kind of virtual pharmacy. I don't think everyone has the resources or the desire to do that. It's very much an operational type of change that needs to occur.

PNOW: What are you using for technology and automation?

DM: It's a proprietary system that's been put together. It has some building blocks from existing technology but it probably looks nothing like the baker cells and some of the other technology that exists in the pharmacy world. For example, the central fulfillment pharmacy in Las Vegas opened in 1996 and cost $85 million to build. A lot of the technology is even further enhanced in the pharmacy that's opening in Willingborough in October. So far, that pharmacy has probably cost about $100 million.

PNOW: What needs do central fulfillment pharmacies serve?

DM: You need to have those to enable those other types of pharmacies to exist. To have a clinical/cognitive setting where the pharmacist does no dispensing, you need to have some highly automated state-of-the-art technology on the back end that can do the dispensing of the product.

PNOW: Are pharmacists involved in the design?

DM: Yes. They have been intimately involved in the design of all of the pharmacies and our clinical programs because of their expertise. We have several more conventional types of pharmacy where pharmacists are involved in the entire drug therapy management process all the way through compounding and dispensing.

PNOW: Do you see a day when pharmacists will be primarily or entirely involved in the cognitive role?

DM: Absolutely. We have seven pharmacies now that have between 150 and 200 pharmacists each. They do nothing except the clinical cognitive thinking and activity. They do no dispensing.

PNOW: Would this be a welcome change for pharmacists who are looking to get away from spending much of their time dispensing?

DM: The probable reason why some people are now pursuing other practice settings is because such a large portion of their activity is involved in motor skills -- counting, licking, sticking and pouring -- and they don't want to do that for 12 hours a day for the rest of their lives. They're looking for alternatives. They're looking for practice settings that will allow them to really use their skills and competencies.

PNOW: Let's switch gears and talk about you. You've been involved in non-dispensing pharmacy for the vast majority of your career. How did you end up here?

DM: I spent six years as a pharmacist in community retail practice. I worked for a small chain, a large chain and an independent. I was trying to find something that allowed me to use the skills I had and to make a difference. I tried to do that in various types of organizations and then I took a step back in 1985-86 to see what else is out there that pharmacists can do. That's when I started my career in managed care pharmacy. I worked for a group model HMO in New York City. I actually started with them as a staff pharmacist. After a very short period of time, I was supervisor and then decided that I really liked the management side. I made a very deliberate decision to move into that. I did that for four years in the group model HMO and then decided that I had learned all I could. So I went to a national insurer that had both IPA and group model health plans. I did that for four and a half years and decided I had learned the insurer side. Then I looked into the pharmacy benefits management. I've been here for five years.

PNOW: How has your career developed at Merck-Medco?

DM: I have held three positions within Merck-Medco. When I started, I was the vice president of clinical programs and a year and a half later, I was asked to take on a large strategic project, which I did for a little over two years. I was then asked to take on this start-up project and build the pharmacy relations department and help with recruiting strategy, marketing and increasing the understanding and awareness of who Merck-Medco is and what we do and, more importantly, what we offer pharmacists. We have been a really well-kept secret for a long time, and I think it matches up more closely with what pharmacists are looking to do now. I think it's well past time that we need to let pharmacists know that there are a lot of options that maybe they don't know about.

PNOW: How do you balance your professional aspirations and workload with your personal life?

DM: I believe that there's really three parts to being a professional. One, you give back and improve patients' lives. Two, you give back to society as a whole. Three, if you are truly a professional, you will always give back to your profession. I have always been actively involved in professional organizations. I have also taken students both as interns and on clinical rotations or externships. I do oversee the managed care pharmacy practice residency and I have spent a lot of my free time giving back to the profession. About two years ago, I made a decision that I had given enough back to pharmacy on the professional organization level. I started to look at other things that are community-based so that I could give back to the community. I now sit on the board of trustees for the Center for Modern Dance Education in New Jersey. As far as balancing, I am probably not the best person because I really take it very seriously that I am a professional and I have always been involved - so the little bit of free time that I have has been mostly spent in pharmacy.

PNOW: Is dance an interest of yours?

DM: Oh yes. I love the theatre. I love the arts. I think I have a creative side that pharmacy hasn't allowed me to bring out.

PNOW: Are there some connections that you can make with your love of art and dance and what you do as a pharmacist?

DM: There have been people along the way in my career who have told me that I truly have a passion for what I do. I have learned that you always want to be in a position where you're making a difference. I believe one person who's really passionate is better than 40 who are merely interested. It's really made a difference in how I view my career and what I can contribute. It's even opened up opportunities for me. If you look at some of the positions I have held, I recognized a need in the organization and carved out and created the position. While I am always a pharmacist, I think that I have been allowed to build and do other things in my career that I might not have ever imagined, when I was graduating from pharmacy school, that I would be doing 20 years later.

PNOW: Is there one thing that you could say has spurred you on in your career?

DM: There has always been the desire to make a difference. I have always been very strategic in my thinking. I can see how things are interdependent and inter-related and I've not allowed anybody to put me in a box of what a pharmacist can do. I have spent a lot of time along the way developing those life or critical skills that usually end up being more important than just your clinical and technical skills.

Person I Most Admire: Nelson Mandela
Favorite Fun/leisure Activity: Read, theatre, music!!
Favorite Book: The Art of War
Favorite Musical Group/Artist: Miles Davis